Aetna controversies
Controversies tied to this brand in public sources. A listing is not a finding of fault.
Back to profile10 entries
2026
Medical-fraud judgment
The supplied reference reports that Aetna received a $117 million judgment against it in a medical-fraud matter. Details should be independently checked against a current court or regulatory source.
2021
Aetna faces protests over cataract preapproval rule
Public backlash
Aetna implemented a requirement that cataract surgery receive preapproval for reimbursement, effective July 1, 2021. Ophthalmologists protested the rule. The American Academy of Ophthalmology reported that the requirement led to delays, confusion, and canceled procedures.
Aetna's requirement that cataract surgery receive preapproval for reimbursement took effect July 1, 2021. Ophthalmologists protested the rule, and the American Academy of Ophthalmology reported delays, confusion, and canceled procedures.
Source excerpt
The requirement, which went into effect July 1, 2021, affects about 20,000 procedures per month and is causing delays and confusion, according to the American Academy of Ophthalmology (AAO).
Ophthalmologists are protesting Aetna's new requirement that it preapprove all cataract surgery as a condition for reimbursement.
2021
Aetna sues New York City over Medicare contract award
Lawsuit filed
Aetna sued New York City and a rival insurers group over a $34 billion Medicare contract. Aetna alleged that the city awarded the contract to unqualified bidders and violated procurement requirements. Aetna asked the court to void the agreement between the city and the Alliance.
Source excerpt
The Hartford health insurer filed a lawsuit in New York Supreme Court earlier this month accusing the city’s Office of Labor Relations of selecting an “inexperienced and unqualified bidder,” violating New York procurement law, lacking transparency and breaching “principles of public trust and fairness for a procurement that could last up to a minimum of five or as many as 11 years and generate $34 billion in claims revenue.”
Aetna is suing New York City and a rival health insurers group over a $34 billion Medicare contract it says was awarded to unqualified bidders.
2021
Aetna sued over denial of residential treatment coverage
Lawsuit filed
A beneficiary filed a lawsuit against Aetna Life Insurance and a benefits plan, alleging improper denial of mental health benefits after Aetna denied further residential treatment coverage. The complaint alleges violations of the Mental Health Parity and Addiction Equity Act and seeks recovery of benefits and damages for breach of fiduciary duty.
Source excerpt
The plaintiff is suing for recovery of benefits and breach of fiduciary duty.
On Friday a case was filed in the Northern District of California by a beneficiary against Aetna Life Insurance and Playworks Education Welfare Benefits Plan. The case is regarding improper denial of mental health benefits under ERISA.
A plaintiff filed suit last Friday in the District of New Jersey against his insurance company, Aetna Inc. and Aetna Life Insurance Company.
2021
Lawsuit filed against Aetna over denied cancer treatment benefits
Lawsuit filed
An ERISA plan benefit recipient filed a lawsuit against Aetna, alleging that Aetna denied coverage for proton beam radiation therapy as an experimental treatment and continued to deny billing despite submitted medical records and appeals. The plaintiff seeks benefits and equitable relief regarding future claims processing.
Source excerpt
Despite the patient and her treating doctors providing medical records, documentation of the treatment’s efficacy and acceptance, and submitting appeals for manual review instead of automated denial of the treatment, Aetna continued to automatically deny the billing, which per the plaintiff violates Aetna’s higher fiduciary duty as a processor of ERISA plan claims.
On Tuesday a case was filed in the District of Arizona by an ERISA plan benefit recipient against Aetna as third party administrator of the plan. The case concerns the denial of benefits by Aetna for Proton Beam Radiation Therapy (PBRT) as an experimental treatment.
The plaintiff argues that this requirement acts as a tax upon these couples that is discriminatory
2021
CVS sues Cigna over alleged Aetna trade-secret misuse
Lawsuit filed
CVS sued Cigna in Rhode Island district court, alleging potential misuse of Aetna confidential information and trade secrets related to its Medicare Advantage strategy. The lawsuit sought punitive damages, legal fees and an order preventing former Aetna executive Timothy M. Brown from working at Cigna for a year; the allegations are not stated as established findings.
Source excerpt
Aetna’s strategy for capturing more of this market was “highly confidential and would be invaluable to Cigna,” according to the lawsuit, which was filed Feb. 9.
Aetna is asking the court for punitive damages, legal fees and an order to prevent Brown from working at Cigna for a year.
The defection of a top Aetna executive has prompted parent company CVS to sue Cigna in Rhode Island district court alleging the potential misuse of trade secrets.
2001
Claims-payment penalties
Maryland regulators cited Aetna among health plans penalized for claims-payment practices and assessed Aetna an $850,000 fine.
2001
Texas payment-practice fine
Texas regulators fined Aetna $1.15 million over alleged delays in paying physicians and hospitals.
1999
Treatment-delay punitive-damages verdict
A California jury awarded punitive damages in a case alleging that an Aetna subsidiary delayed approval of cancer treatment. The matter was later settled in 2001.
1850
Historical insurance of enslaved people
Records indicated that predecessor-era Aetna businesses issued life-insurance policies on enslaved African Americans, with enslavers named as beneficiaries. Aetna publicly apologized in 2000.